The Clinical Problem Solvers Episode 450: Schema Episode – AKI and 20 questions
17 snips
Mar 14, 2026 A complex AKI case drives a rapid-fire question format exploring pre, post, and intrarenal causes. Detailed urinalysis interpretation and sudden severe azotemia prompt discussion of lab artifacts and chronicity. Bloodwork reveals microangiopathic hemolysis and thrombotic microangiopathy. Debate centers on distinguishing GN, malignant hypertension, and complement‑mediated TMA and the urgency of biopsy and targeted therapy.
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Always Get And Sometimes Repeat A Urinalysis
- Do get a urinalysis early for every AKI to screen for intrarenal processes like GN or interstitial nephritis.
- Mark and Yusuf recommend repeating the UA later if the first was from a concentrated ED specimen to avoid false positives.
Describe UA Findings Specifically
- Read the UA beyond 'dirty' versus 'clean' by reporting pyuria, hematuria, and proteinuria separately to narrow etiologies.
- Mark details that pyuria suggests cystitis or interstitial nephritis, hematuria suggests GN or other bleeding sources, and proteinuria is rarely normal.
Call Nephrology Early For Extreme Labs
- Act quickly when lab derangements are extreme: assess AEIOU dialysis criteria and call nephrology early for severe BUN/creatinine elevations.
- Maddy highlights BUN 135 and creatinine 24 as red flags that may necessitate urgent dialysis despite clinical context.